The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans (2008)

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Appendix B Exposure Measures in Studies of U.S. Vietnam Veterans 119 

TABLE B-1  Exposure Measures in Studies of U.S. Vietnam Veterans 120 Sources of Reference Design Description Exposure Data Exposure Measures CDC Studies Erickson Case-control CDC Birth Defects Study Telephone interview Veteran (ever served in U.S. military) et al., Birth defect cases and Military records Vietnam service before conception of case/control offspring 1984a,b normal controls born in EOI (values 1–5): scores assigned on the basis of reviews the Atlanta, GA, area, by Army experts of duties, dates, and places of service 1968–1980 in Vietnam; separate scores for information from (1) interviews and (2) review of military records Self-reports of Agent Orange exposure Boyle et al., Retrospective CDC Vietnam Experience Military records Army service in Vietnam between 1965 and 1971 1987; cohort Study: Mortality in CDC, Vietnam and Vietnam- 1987 era veterans CDC, 1988 Cohort CDC Vietnam Experience Military records Army service in Vietnam between 1965 and 1971 a,b,c, Study: Psychosocial, Telephone interview Self-reported exposures 1989 physical health, and reproductive outcomes CDC, Cohort pilot CDC Agent Orange Military records Five scores based on military records; two scores based on 1988d Validation Study Self-report through information from self-report Army Vietnam veterans and structured The scoring methods based on information from military Vietnam-era controls interview records reflected different assumptions about TCDD half-life and about completeness of data on troop and herbicide spray locations 

Two other scores were based on information from the structured interview (self-report): number of days of direct exposure to herbicides during military service; and number of days of indirect exposure to herbicides during military service CDC, 1990 Case-control Selected Cancer Studies: Telephone interview, Self-reported Vietnam service (in sensitivity analyses, service a,b,c,d Studies of NHL, HD, supplemented by in Vietnam distinguished from service off the coast) STS, nasal carcinoma, review of military Considered branch of service, unit, location in Vietnam, nasopharyngeal records job duties, tour of duty, rank, perceived exposure to carcinoma, liver cancer Classification of unit herbicides mission by U.S. Non-Vietnam occupational exposure to phenoxy herbicides Army ESG O’Brien et Cohort NHL cases identified within Military records Vietnam service, noting region of service and military al., 1991 Vietnam Experience Interview occupation Study cohort Decouflé et Cohort Vietnam Experience Study Military records Herbicide exposure index reflecting four categories of al., 1992 Relationship of self- Telephone increasing intensity of exposure based on self-report reported health to questionnaire self-reported exposure to herbicides and combat among Army veterans Boehmer et Cohort Mortality update of Military records Entered military service 1965–1971, at least one tour of al., 2004 Vietnam Experience Army service in Vietnam Study cohort 121 continued 

TABLE B-1  Continued 122 Sources of Reference Design Description Exposure Data Exposure Measures Department of Veterans Affairs Studies Kang et al., Case-control Hospital-based study of Military records Vietnam service 1986 Vietnam and Vietnam- era veterans diagnosed with STS, 1969–1983 Burt et al., Retrospective NHL mortality among Military records Service as a member of Army or Marine Corps in Vietnam 1987 cohort Vietnam and Vietnam- between July 4, 1965, and March 1, 1973 era Army and Marine Corps veterans Kang et al., Case-control STS cases diagnosed at Military records Vietnam service in Army or Marine Corps, combat-related 1987 Armed Forces Institute Telephone interview military occupation, and broad geographic location of of Pathology (1975– individual’s unit at time of service 1980); controls from patient logs of referring pathologists Breslin et Retrospective Mortality among Vietnam Military records Service as a member of Army or Marine Corps in Vietnam al., 1988 cohort and Vietnam-era Army between July 4, 1965, and March 1, 1973 and Marine Corps veterans True et al., Cross- Military service in Vietnam Questionnaire Exposure to combat in Vietnam 1988 sectional and subsequent posttraumatic stress disorder symptoms 

Bullman et Cohort Mortality in Army Vietnam Military records Service in Military Region I al., 1990 and Vietnam-era veterans who served in Military Region I Farberow et Case-control Suicide and motor vehicle Military records Vietnam service, combat-related military occupation based al., 1990 deaths in Los Angeles Medical examiner’s on military records; aspects of military experience based County among Vietnam records on next-of-kin report and Vietnam-era Army Next-of-kin and Marine Corps interviews veterans Goldberg et Cohort Posttraumatic stress Military records Southeast Asia service al., 1990 disorder among Questionnaire monozygotic twin pairs serving in the military during the Vietnam era Bullman et Case-control Combat and other Military records Vietnam service in a combat-related military occupation, al., 1991 service experience in having been wounded in Vietnam, having been awarded posttraumatic stress medals for combat-related Vietnam service disorder cases and controls selected from the VA Agent Orange Registry Dalager et Case-control Vietnam and Vietnam-era Military records Branch of service, combat role, service within a specific al., 1991 veterans diagnosed with region in Vietnam, extended service in Vietnam NHL in VA hospitals, 1969–1985 123 continued 

TABLE B-1  Continued 124 Sources of Reference Design Description Exposure Data Exposure Measures Eisen et al., Cohort Health status of Mail survey or Southeast Asia service 1991 monozygotic twin telephone pairs who served in interviews the military during the Vietnam era Thomas et Cohort Mortality in women Military records Vietnam service al., 1991 Vietnam veterans and Vietnam-era veterans deceased 1973–1987 Watanabe Retrospective Follow-up through 1984 Military records Army or Marine Corps service in Vietnam between July 4, et al., cohort of mortality study by 1965, and March 1, 1973 1991 Breslin et al., 1988 Bullman et Case-control Testicular cancer cases Military records Branch of service, type of duty, corps area, and location of al., 1994 and controls identified individual’s unit in relation to recorded Agent Orange from VA Agent Orange spray tracks Registry Dalager Cohort Mortality study of women Military records Vietnam service et al., Vietnam veterans and 1995a Vietnam-era veterans who died 1965–1992 Update of Thomas et al., 1991 

Dalager Case-control Vietnam and Vietnam-era Military records Branch of service, combat role, service within a specific et al., veterans diagnosed with region in Vietnam, extended service in Vietnam 1995b Hodgkin’s disease in VA hospitals, 1969–1985 Watanabe Cohort Mortality study of U.S. Military records Vietnam service and Marine Vietnam and Kang, Vietnam-era veterans 1995 Extension of Breslin et al., 1988, and Watanabe et al., 1991 Watanabe Cohort Mortality study of Army Military records Vietnam service and and Marine Corps Kang, Vietnam and Vietnam- 1996 era veterans who died 1965–1988 Mahan et Case-control Lung cancer cases among Military records Vietnam service al., 1997 Vietnam-era veterans Location of service member’s unit in relation to areas sprayed with herbicides and time elapsed since spraying McKinney Cross- Smoking patterns 1987 National Vietnam service et al., sectional among veterans and Medical 1997 non-veterans Expenditure Survey Kang et al., Cohort Self-reported pregnancy Military records Vietnam service 2000a outcomes for women Structured telephone Vietnam and Vietnam- interview era veterans 125 continued 

TABLE B-1  Continued 126 Sources of Reference Design Description Exposure Data Exposure Measures Kang et al., Cohort Gynecologic cancers among Military records Vietnam service 2000b women Vietnam and Structured telephone Vietnam-era veterans interview State Studies Greenwald Case-control STS cases from New York Interview of study Self- or proxy report of Vietnam service, exposure to Agent et al., State Cancer Registry, subjects or next Orange 1984 diagnosed 1962–1980; of kin population controls Newell, Cross- Pilot analyses of Military records Exposure to herbicides based on the amount of herbicide 1984 sectional cytogenetics, sperm Questionnaire sprayed in the area where the individual served during evaluation, and immune period of service response in Vietnam Reported presence of chloracne veterans from Texas Kogan and Cohort Mortality study of List of Massachusetts Vietnam service Clapp, Massachusetts Vietnam veterans who 1985 and Vietnam-era served between veterans, deceased 1958 and 1973 1972–1983 and received a bonus Lawrence et Cohort Mortality study of veterans Military records Vietnam service al., 1985 discharged from (Vietnam service service 1971–1973 and indicators in deceased in New York DMDC roster) through 1980 

Rellahan, Cohort Survey of residents of Oahu, Questionnaire Vietnam service 1985 Hawaii, with Vietnam- era military service Wendt, Descriptive Survey of Iowa Vietnam Iowa Department of Self-reported spraying or handling of Agent Orange, or 1985 and Vietnam-era Veterans Affairs passing through a sprayed area veterans records Questionnaire Anderson et Cohort Mortality study of Military records Vietnam service al., 1986 Wisconsin Vietnam veterans, Vietnam- era veterans, and non-veterans Goun and Case-control Mortality from STS, NHL, Federal military Vietnam service Kuller, and other cancers among records 1986 Pennsylvania male Commonwealth Vietnam veterans of Pennsylvania Department of Military Affairs records Holmes et Cohort Mortality study of West List of recipients Vietnam service al., 1986 Virginia Vietnam of West Virginia veterans Vietnam-era service bonus 127 continued 

TABLE B-1  Continued 128 Sources of Reference Design Description Exposure Data Exposure Measures Pollei et al., Case-control Chest radiographs of Interviews; some Registry enrollment; self-reported repeated exposure to 1986 Vietnam veterans military records Agent Orange in Albuquerque VA Agent Orange registry; compared to Air Force personnel with no Vietnam service Kahn et al., Pilot Herbicide exposure Self report, validated Highly exposed to Agent Orange (by job title and 1988 exposure study of Vietnam and with examination self-report) study Vietnam-era veterans of military records Adipose tissue and blood serum measurement of TCDD by U.S. Army ESG Kogan and Cohort Mortality study of List of Massachusetts Vietnam service Clapp, Massachusetts Vietnam veterans who 1988 and Vietnam-era served between veterans, deceased 1958 and 1973 1972–1983; focus on and received a cancer mortality bonus Levy, 1988 Cross- PTSD in those with Telephone interview Current diagnosis of chloracne sectional chloracne among a Medical examination subset of Massachusetts Vietnam bonus recipients 

Clapp et Case-control Cancer cases from List of Massachusetts Vietnam service al., 1991 Massachusetts Cancer veterans who Registry, diagnosed served between 1982–1988 1958 and 1973 and received a bonus Deprez et Descriptive Health status and Questionnaire Self-reported exposure to herbicides al., 1991 reproductive outcomes in Maine Vietnam veterans Fiedler Cohort Health outcomes in New Self report, validated TCDD in blood; service in units that operated in heavily et al., Jersey Vietnam and with examination sprayed areas of Vietnam 1992; Vietnam-era veterans of military records Kahn by U.S. Army et al., ESG 1992a,b Visintainer Cohort Mortality study of Michigan bonus list Vietnam service (“in-country” versus “out-country”) et al., Michigan Vietnam and 1995 Vietnam-era veterans Clapp, Case-control Cancer cases from List of Massachusetts Vietnam service 1997 Massachusetts Cancer veterans who Registry, diagnosed served between 1982–1993 1958 and 1973 Update of Clapp et al., and received a 1991 bonus 129 continued 

TABLE B-1  Continued 130 Sources of Reference Design Description Exposure Data Exposure Measures American Legion Studies Snow et al., Cohort Health and reproductive Questionnaire Scale of combat intensity based on self-report 1988 outcomes among American Legion members who served in Vietnam, examining combat and herbicide exposures Stellman Cohort Social and behavioral Questionnaire Separate exposure opportunity indexes for Agent Orange et al., outcomes among and for all herbicides, based on 1986 proximity model 1988a American Legion using HERBS and Services HERBS tapes and point members who served locations for centers of major troop activity in Vietnam, examining combat and herbicide exposures Stellman Cohort Health and reproductive Questionnaire Separate exposure opportunity indexes for Agent Orange et al., outcomes among and for all herbicides, based on 1986 proximity model 1988b American Legion using HERBS and Services HERBS tapes and point members who served locations for centers of major troop activity in Vietnam, examining combat and herbicide exposures 

Other Studies of Vietnam Veterans Aschengrau Case-control Paternal Vietnam service Federal military Vietnam service and and risk of spontaneous records Monson, abortion Massachusetts 1989 Vietnam bonus list Aschengrau Case-control Paternal Vietnam service Federal military Vietnam service and and risk of late adverse records Monson, pregnancy outcomes Massachusetts 1990 Vietnam bonus list Tarone et Case-control Vietnam veterans with Questionnaire Vietnam service al., 1991 testicular cancer and hospital controls with other cancers NOTES: Excludes studies of the Air Force Health Study (Ranch Hand) and Army Chemical Corps cohorts. CDC, Centers for ­Disease ­Control and P ­ revention; DMDC, Defense Manpower Data Center; EOI, exposure opportunity index; ESG, U.S. Army and Joint Services Envi­ronmental Support Group; NHL, non-Hodgkin’s lymphoma; PTSD, posttraumatic stress disorder; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin. SOURCE: Adapted from Table C-3 (IOM, 2007). 131 

132 PROXIMITY-BASED HERBICIDE EXPOSURE ASSESSMENT REFERENCES Anderson, H. A., L. P. Hanrahan, M. Jensen, D. Laurin, W. Y. Yick, and P. Wiegman. 1986. Wisconsin Vietnam veteran mortality study: Final report. Madison: Wisconsin Division of Health. Aschengrau, A., and R. R. Monson. 1989. Paternal military service in Vietnam and risk of spontaneous abortion. Journal of Occupational Medicine 31(7):618–623. Aschengrau, A., and R. R. Monson. 1990. Paternal military service in Vietnam and the risk of late adverse pregnancy outcomes. American Journal of Public Health 80(10):1218–1224. Boehmer, T. K., W. D. Flanders, M. A. McGeehin, C. Boyle, and D. H. Barrett. 2004. Post- service mortality in Vietnam veterans: 30-year follow-up. Archives of Internal Medicine 164(17):1908–1916. Boyle, C. A., P. Decouflé, R. J. Delaney, F. DeStefano, M. L. Flock, M. I. Hunter, M. R. ­Joesoef, J. M. Karon, M. L. Kirk, P. M. Layde, D. L. McGee, L. A. Moyer, D. A. Pollock, P. Rhodes, M. J. Scally, and R. M. Worth. 1987. Postservice mortality among Vietnam veterans. Atlanta, GA: Centers for Disease Control, U.S. Department of Health and Human Services. Breslin, P., H. K. Kang, Y. Lee, V. Burt, and B. Shepard. 1988. Proportionate mortality study of US Army and US Marine Corps veterans of the Vietnam War. Journal of Occupational Medicine 30(5):412–419. Bullman, T. A., H. K. Kang, and K. K. Watanabe. 1990. Proportionate mortality among U.S. Army Vietnam veterans who served in Military Region I. American Journal of Epidemi- ology 132(4):670–674. Bullman, T. A., H. K. Kang, and T. L. Thomas. 1991. Posttraumatic stress disorder among Vietnam veterans on the Agent Orange Registry: A case-control analysis. Annals of Epidemiology 1(6):505–512. Bullman, T. A, K. K. Watanabe, and H. K. Kang. 1994. Risk of testicular cancer associated with surrogate measures of Agent Orange exposure among Vietnam veterans on the Agent Orange Registry. Annals of Epidemiology 4:11–16. Burt, V. L., P. P. Breslin, H. K. Kang, and Y. Lee. 1987. Non-Hodgkin’s lymphoma in Vietnam veterans. Department of Medicine and Surgery, U.S. Veterans Administration, Washing- ton, DC. CDC (Centers for Disease Control and Prevention). 1987. Postservice mortality among Viet- nam veterans. Journal of the American Medical Association 257(6):790–795. CDC. 1988a. Health status of Vietnam veterans: I. Psychosocial characteristics. Journal of the American Medical Association 259(18):2701–2707. CDC. 1988b. Health status of Vietnam veterans: II. Physical health. Journal of the American Medical Association 259(18):2708–2714. CDC. 1988c. Health status of Vietnam veterans: III. Reproductive outcomes and child health. Journal of the American Medical Association 259(18):2715–2719. CDC. 1988d. Serum 2,3,7,8-tetrachlorodibenzo-p-dioxin levels in U.S. Army Vietnam-era veterans. Journal of the American Medical Association 260(9):1249–1254. CDC. 1989. Health status of Vietnam veterans: Vietnam Experience Study. Volumes I–V, Supplements A–C. Available: http://www.cdc.gov/nceh/veterans/default1c.htm (accessed December 21, 2007). CDC. 1990a. The association of selected cancers with service in the U.S. military in Vietnam: I. Non-Hodgkin’s lymphoma. Archives of Internal Medicine 150:2473–2483. CDC. 1990b. The association of selected cancers with service in the U.S. military in Vietnam: II. Soft-tissue and other sarcomas. Archives of Internal Medicine 150:2485–2492. 

APPENDIX B 133 CDC. 1990c. The association of selected cancers with service in the U.S. military in Vietnam: III. Hodgkin’s disease, nasal cancer, nasopharyngeal cancer, and primary liver cancer. Archives of Internal Medicine 150:2495–2505. CDC. 1990d. The association of selected cancers with service in the U.S. military in Vietnam: Final report. Atlanta, GA: U.S. Department of Health and Human Services. Clapp, R. W. 1997. Update of cancer surveillance of veterans in Massachusetts, USA. Inter- national Journal of Epidemiology 26(3):679–681. Clapp, R. W., L. A. Cupples, T. Colton, and D. M. Ozonoff. 1991. Cancer surveillance of veterans in Massachusetts, USA, 1982–1988. International Journal of Epidemiology 20(1):7–12. Dalager, N. A., H. K. Kang, V. L. Burt, and L. Weatherbee. 1991. Non-Hodgkin’s lymphoma among Vietnam veterans. Journal of Occupational Medicine 33(7):774–779. Dalager, N. A., H. K. Kang, and T. L. Thomas. 1995a. Cancer mortality patterns among women who served in the military: The Vietnam experience. Journal of Occupational and Environmental Medicine 37(3):298–305. Dalager, N. A., H. K. Kang, V. L. Burt, and L. Weatherbee. 1995b. Hodgkin’s disease and Vietnam service. Annals of Epidemiology 5(5):400–406. Decouflé, P., P. Holmgreen, C. Boyle, and N. Stroup. 1992. Self-reported health status of Vietnam veterans in relation to perceived exposure to herbicides and combat. American Journal of Epidemiology 135(3):312–323. Deprez, R. D., M. E. Carvette, and M. S. Agger. 1991. The health and medical status of Maine veterans: Final report. Portland, ME: Public Health Resource Group, Inc. Eisen, S., J. Goldberg, W. R. True, and W. G. Henderson. 1991. A co-twin control study of the effects of the Vietnam War on the self-reported physical health of veterans. American Journal of Epidemiology 134:49–58. Erickson, J. D., J. Mulinare, P. W. McClain, T. G. Fitch, L. M. James, A. B. McClearn, and M. J. Adams, Jr. 1984a. Vietnam veterans’ risks for fathering babies with birth defects. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Con- trol and Prevention. Erickson, J. D., J. Mulinare, P. W. McClain, T. G. Fitch, L. M. James, A. B. McClearn, and M. J. Adams, Jr. 1984b. Vietnam veterans’ risks for fathering babies with birth defects. Journal of the American Medical Association 252(7):903–912. Farberow, N. L., H. K. Kang, and T. A. Bullman. 1990. Combat experience and postservice psychosocial status as predictors of suicide in Vietnam veterans. Journal of Nervous and Mental Disease 178(1):32–37. Fiedler, N., M. Gochfeld, and W. W. Lewis. 1992. The Pointman Project: Neuro­behavioral correlates of herbicide exposure in Vietnam veterans. New Jersey Agent Orange Commission. Goldberg, J., W. R. True, S. A. Eisen, and W. G. Henderson. 1990. A twin study of the effects of the Vietnam War on posttraumatic stress disorder. Journal of the American Medical Association 263(9):1227–1232. Goun, B. D., and L. H. Kuller. 1986. Final report: A case control study on the association of soft tissue sarcomas, non-Hodgkin’s lymphomas, and other selected cancers and Vietnam military service in Pennsylvania males. Pittsburgh, PA: University of Pittsburgh. Greenwald, P., B. Kovasznay, D. N. Collins, and G. Therriault. 1984. Sarcomas of soft tissues after Vietnam service. Journal of the National Cancer Institute 73:1107–1109. Holmes, A. P., C. Bailey, R. C. Baron, E. Bosanac, J. Brough, C. Conroy, and L. Haddy. 1986. Vietnam-era veterans mortality study, West Virginia residents, 1968–1983: Preliminary report. Charleston: West Virginia Department of Health. IOM. 2007. Veterans and Agent Orange: Update 2006. Washington, DC: The National Academies Press. 

134 PROXIMITY-BASED HERBICIDE EXPOSURE ASSESSMENT Kahn, P. C., M. Gochfeld, M. Nygren, M. Hansson, C. Rappe, H. Velez, T. Ghent-Guenther, and W. P. Wilson. 1988. Dioxins and dibenzofurans in blood and adipose tissue of Agent Orange-exposed Vietnam veterans and matched controls. Journal of the American Medi- cal Association 259(11):1661–1667. Kahn, P. C., M. Gochfeld, and W. W. Lewis. 1992a. Immune status and herbicide exposure in the New Jersey Pointman I Project. New Jersey Agent Orange Commission. Kahn, P. C., M. Gochfeld, and W. W. Lewis. 1992b. Semen analysis in Vietnam veterans with respect to presumed herbicide exposure. Pointman II Project. New Jersey Agent Orange Commission. Kang, H. K., L. Weatherbee, P. Breslin, Y. Lee, and B. Shepard. 1986. Soft tissue sarcomas and military service in Vietnam: A case comparison group analysis of hospital patients. Journal of Occupational and Environmental Medicine 28(12):1215–1218. Kang, H. K., F. Enziger, P. Breslin, M. Feil, Y. Lee, and B. Shepard. 1987. Soft tissue sarcoma and military service in Vietnam: A case-control study. Journal of the National Cancer Institute 79(4):693–699. Kang, H. K., C. M. Mahan, K. Y. Lee, C. A. Magee, S. H. Mather, and G. M. Matanoski. 2000a. Pregnancy outcomes among U.S. women Vietnam veterans. American Journal of Industrial Medicine 38:447–454. Kang, H. K., C. M. Mahan, K. Y. Lee, C. A. Magee, and S. Selvin. 2000b. Prevalence of gynecologic cancers among female Vietnam veterans. Journal of Occupational and Envi­ ronmental Medicine 42(11):1121–1127. Kogan, M. A., and R. Clapp. 1985. Mortality among Vietnam veterans in Massachusetts, 1972–1983. Office of the Commissioner of Veterans’ Services, Agent Orange Program. The Commonwealth of Massachusetts. Kogan, M. A., and R. Clapp. 1988. Soft tissue sarcoma mortality among Vietnam veterans in Massachusetts, 1972–1983. International Journal of Epidemiology 7(1):39–43. Lawrence, C. E., A. A. Reilly, P. Quickenton, P. Greenwald, W. F. Page, and A. J. Kuntz. 1985. Mortality patterns of New York State Vietnam veterans. American Journal of Public Health 75:277–279. Levy, C. J. 1988. Agent Orange exposure and posttraumatic stress disorder. Journal of ­ ervous and Mental Disease 176(4):242–245. N Mahan, C. M., T. A. Bullman, and H. K. Kang. 1997. A case-control study of lung ­cancer among Vietnam veterans. Journal of Occupational and Environmental Medicine 39(8):740–747. McKinney, W. P., D. D. McIntire, T. J. Carmody, and A. Joseph. 1997. Comparing the smoking behavior of veterans and nonveterans. Public Health Reports 112:212–217. Newell, G. R. 1984. Development and preliminary results of pilot clinical studies: Report of the chairman. Agent Orange Advisory Committee to the Texas Department of Health. O’Brien, T. R., P. Decouflé, and C. A. Boyle. 1991. Non-Hodgkin’s lymphoma in a cohort of Vietnam veterans. American Journal of Public Health 81(6):758–760. Pollei, S., F. A. Mettler, Jr., C. A. Kelsey, M. R. Walters, and R. E. White. 1986. Follow-up chest radiographs in Vietnam veterans: Are they useful? Radiology 161:101–102. Rellahan, W. 1985. Aspects of the health of Hawaii’s Vietnam-era veterans reflecting the ­mpact of the Vietnam experience. Hawaii Department of Health. i Snow, B. R., J. M. Stellman, S. D. Stellman, and J. F. Sommer, Jr. 1988. Post-traumatic stress disorder among American Legionnaires in relation to combat experience in Vietnam: Associated and contributing factors. Environmental Research 47(2):175–192. Stellman, J. M., S. D. Stellman, and J. F. Sommer, Jr. 1988a. Social and behavioral con- sequences of the Vietnam experience among American Legionnaires. Environmental Research 47(2):129–149. 

APPENDIX B 135 Stellman, J. M., S. D. Stellman, and J. F. Sommer, Jr. 1988b. Utilization, attitudes, and e ­ xperiences of Vietnam era veterans with Veterans Administration health facilities: The American Legion experience. Environmental Research 47(2):150–174. Tarone, R. E., H. M. Hayes, R. N. Hoover, J. F. Rosenthal, L. M. Brown, L. M. Pottern, N. Javadpour, K. J. O’Connell, R. E. Stutzman. 1991. Service in Vietnam and risk of testicular cancer. Journal of the National Cancer Institute 83(20):1497–1499. Thomas, T. L., H. K. Kang, and N. A. Dalager. 1991. Mortality among women Vietnam vet- erans, 1973–1987. American Journal of Epidemiology 134(9):973–980. True, W. R., J. Goldberg, and S. A. Eisen. 1988. Stress symptomatology among Vietnam vet- erans. American Journal of Epidemiology 128(1):85–92. Visintainer, P., M. Barone, H. McGee, and E. L. Peterson. 1995. Proportionate mortality study of Vietnam-era veterans of Michigan. Journal of Occupational and Environmental Medicine 37(4):423–428. Watanabe, K. K., and H. K. Kang. 1995. Military service in Vietnam and the risk of death from trauma and selected cancers. Annals of Epidemiology 5:407–412. Watanabe, K. K., and H. K. Kang. 1996. Mortality patterns among Vietnam veterans. Journal of Occupational and Environmental Medicine 38(3):272–278. Watanabe, K. K., H. K. Kang, and T. L. Thomas. 1991. Mortality among Vietnam veterans: With methodological considerations. Journal of Occupational and Environmental Medi- cine 33(7):780–785. Wendt, A. S. 1985. Iowa Agent Orange survey of Vietnam veterans. Iowa State Department of Health.